The discussion on use of nipple shields has been really interesting.  In
my hospital they used to be given out like candy and now even if I need
one, there are none to be found.  Some lactnetters referred to Paula
Meier's research on nipple shield use with preemies, but we have to
remember one thing:.  Preemie moms have usually been pumping for weeks
if not months before the baby comes to breast, and, unlike the mom in
the first 3 days, she has a copious milk supply.  In fact, the shield
actually acts like a barrier to prevent the baby from experiencing an
overwhelming flow the first time he feeds, and stabilizes the breast in
his mouth.  And of course, preemies are being monitored for milk
transfer by pre and post weighing.  
ON the other hand, I still don't understand how a baby can transfer
colostrum with a shield if I cannot even hand express more than a few
drops.  I do like for the mom and the baby to get the feel of baby at
breast, and if the shield is the only way, then of course, we do it, but
this is not considered nourishment for the baby in the first few days.  
I am doing an in-service for the nurses next month and am in a quandary
on how to approach the subject.  I think that I will tell them that
there is a very special way to use NS and if anyone wants to learn, they
should ask me and I will work with them one on one.  I like the vacuum
extraction analogy!!
 
Esther Grunis, IBCLC
Lis Maternity Hospital
Tel Aviv, Israel
 

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